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<body style="padding:10px">

    <form name="form1" method="post" id="form1">
<div>
</div>
	<table class="cnfrmheader">
	    <tr align="center">
		<td colspan="4">
			<h1>城市店名招牌（条直幅）设置申请表</h1>
		</td>
	   </tr>
	   <tr >
	       <th align="right">
			编号：
		</th>
                <td align="left">
                    （20110918001）
                </td>
	        <th align="right">
			申请时间：
		</th>
                <td align="left">
                    <input name="txtDate" type="text" id="txtDate" ltype="date" />
                </td>
	    </tr>
	</table>
        <table class="cnfrmsrch2" width="800px">
	               <tr>
                <th rowspan="2" width="120px">申请单位<br><br/>( 签章 )</th>
                <td  rowspan="2" width="330px">
			<input name="txtName" type="text" id="txtName" ltype="text"  ligerui="{width : 320}"/>
		</td>
                <th width="120px">联系人</th>
                <td width="230px"><input name="txtName" type="text" id="txtName" ltype="text" /></td>
		
            </tr>
	    <tr>
                <th>电话</th>
                <td><input name="txtName" type="text" id="txtName" ltype="text" /></td>
            </tr>
 	    <tr>
                <th>店招名称</th>
                <td><input name="txtName" type="text" id="txtName" ltype="text"  ligerui="{width : 320}"/></td>
                <th>设置规格（长宽高）</th>
                <td>
		<span><input name="txtName" type="text" id="txtName" style="width:50px"/>&nbsp;X&nbsp;<input name="txtName" type="text" id="txtName" style="width:50px"/>&nbsp;X&nbsp;<input name="txtName" type="text" id="txtName" style="width:50px"/></span>
		</td>
            </tr>
	    <tr>
                <th>设置地址</th>
                <td colspan="3"><input name="txtName" type="text" id="txtName" ltype="text"  ligerui="{width : 585}"/></td>
            </tr>
	    <tr>
                <th rowspan="2">设计单位<br><br/>( 签章 )</th>
                <td  rowspan="2"><input name="txtName" type="text" id="txtName" ltype="text"  ligerui="{width : 320}"/></td>
                <th>联系人</th>
                <td><input name="txtName" type="text" id="txtName" ltype="text""/></td>
		
            </tr>
	    <tr>
                <th>电话</th>
                <td><input name="txtName" type="text" id="txtName" ltype="text""/></td>
            </tr>
	    <tr>
                <th rowspan="2">施工单位<br><br/>( 签章 )</th>
                <td  rowspan="2"><input name="txtName" type="text" id="txtName" ltype="text"  ligerui="{width : 320}"/></td>
                <th>联系人</th>
                <td><input name="txtName" type="text" id="txtName" ltype="text"/></td>
		
            </tr>
	    <tr>
                <th>电话</th>
                <td><input name="txtName" type="text" id="txtName" ltype="text"/></td>
            </tr>
	    <tr>
                <th>施工期限</th>
                <td colspan="3"></td>
            </tr>
	    <tr>
                <th>设置期限</th>
                <td colspan="3"></td>
            </tr>
        </table>
 <br />
<input type="submit" value="提交" id="Button1" class="l-button l-button-submit" /> 
<input type="reset" value="重置" class="l-button l-button-reset"/>
    </form>
    <div style="display:none">
    <!--  数据统计代码 --></div> 
</body>
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